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Wait, What? Eliminating A Waitlist for Mental Health Services During a Pandemic: A Case Study
Wait, What? Eliminating A Waitlist for Mental Health Services During a Pandemic: A Case Study

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How often have you tried to increase staff engagement in an improvement initiative? 

You have created project charters and outcomes with desired metrics or key deliverables aligned with the strategic plan. 

You know that your team believes the project will improve patient/client and staff outcomes. 

Yet, despite all your efforts, it gets stalled out or worse, you can't get it started due to ever-increasing demands. 

The Canadian Mental Health Association (CMHA) - Windsor-Essex County Branch senior leadership team experienced (and then overcame) all these challenges. 

In 2019/2020, the leadership team at CMHA completed our Evolution of Thinking™ program. Within less than six months after completing the course AND amid the global Covid-19 pandemic, they achieved the impossible. 

Knocking down an impressive target they'd been wrestling with since 2016, the team eliminated the waitlist for the "Focused Recovery Program (FRP)," mental health services grounded in the recovery philosophy.

Overview

The senior leadership team at CMHA needed to change their service delivery model to better serve people with moderate to severe mental health and addiction issues by addressing the challenge of a waitlist that had ballooned to six months. 

By changing the service model to focus on client goals and recovery, the objective was to enable rapid access to appropriate service while referring on clients who needed longer-term management or specialized support. 

Some of their additional goals included reducing staff burnout and increasing satisfaction and engagement by balancing workloads and increasing caseworker competencies. 

The CMHA team faced many obstacles to their improvement initiative. 

In addition to an increased demand for service during the pandemic, the union raised a significant barrier fixed in the perspective that this new model would lead to diminished clinical outcomes. They went so far as to label it 'fast-food care' - quick visits with poorer quality. A Big-Mac outcome, or so they thought…  

Approach

How did CMHA leaders use their training to evolve their thinking and create different results? 

The project leads made sure they were clear about the vision for this initiative and how it aligned with the organization's vision of 'Mentally Healthy People in a Healthy Society". They made sure to regularly communicate the vision during all planning meetings and ensured that front-line providers were connected to it, creating more clarity and engagement with the project outcomes. 

Through practicing alignment to a common vision, a complexity leadership tool gained through the Evolution of Thinking™ Program, CMHA leaders could address and manage concerns about lack of fairness and inequity in the new model of care. 

A change in mindset

Even though Marilyn Weller, Senior Manager, was aligned with the project vision, leading the change wasn't automatic for her. She needed to lean into her complexity leadership training to get fully on board with her role on the project. 

Recalling her training, Marilyn challenged her assumptions about fairness and how staff might react to the proposed changes. She examined her threat responses around inequity and asked herself; - "How do we make this fair'? 

She recognized she had to shift from a reactive mindset (fear of the potential defensive reactions from staff) to a creative one (experimenting to achieve goals.) 

In making the shift, she facilitated difficult conversations for staff about their perceived loss of autonomy and discomfort in discharging clients to other services despite long-term relationships.

By anchoring herself in the project's vision, Marilyn navigated through the discomfort and faced her own emotional reactions and those of her staff while maintaining a focus on and commitment to the results. 

Additional tools such as PFC (Performance, Focus, Commitment) helped keep Marilyn focused on critical priorities instead of getting swept up in the pandemic crisis.

Increasing staff and leadership capabilities and confidence

For CMHA, navigating a challenging service-model redesign at the most demanding time increased both staff and leaders' capabilities and confidence.

As Michelle Drouillard, Senior Operations Officer, shared, 

"3 years ago, front-line staff would have said this project was a manager's problem. However, during this project, front-line staff were empowered to be involved and think outside the box. The result was the emergence of creative solutions that no one anticipated, including the formation of passionate committees led by the front-line workers themselves!"

Another unanticipated and creative solution was for the case managers to identify clients not currently engaged in services. By highlighting inactive cases, the team dramatically increased their ability to add new clients to caseloads and created a culture shift in their team that allowed for more engagement, focus on performance and increased trust. 

In a further effort to improve the effectiveness and responsiveness of their services, the CMHA team instigated a Documentation Review Committee comprised of staff from each mental health program. The committee worked hard to improve documentation (progress note templates, intake assessment tools, internal referral tools, and other agency documentation), resulting in more accurate and timely identification and referral.

As the program redesign evolved, the CMHA team created and revised the client orientation checklist, recovery action plans, a welcome letter for new clients, and other tools to assist clients and workers in the recovery process. 

The collaborative process at the heart of the service model delivery project worked exceptionally well, bringing leadership and front-line staff together to address everyday needs. CMHA staff quickly invested in the redesign and served as "champions" for their colleagues to build excitement and buy-in.  

Results and Outcomes

In January 2021, CMHA completed a Housing Redesign Project that was a necessary step in improving access to appropriate levels of care. The Housing redesign project shifted clients into different programs with re-assigned staff (Housing Case Managers), building more capacity for the ICM/FRP caseloads and creating space for implementing the new case management model in June 2021. 

After six months of implementation, here are the results: 

Client Outcomes
  • ZERO client waitlist since August 2021
  • The "Focused Recovery Program' officially launched on October 4th, 2021
  • 250 additional clients have since come through the doors
  • Same-day service is now the norm. Clients seeking service usually receive a 'SAME DAY' supportive call to arrange the first meeting from a caseworker. Before the program redesign, clients could wait up to 6 months after being referred to begin the care with the case manager. 
Staff Outcomes 
  • Increased staff engagement and satisfaction
  • Staff are driving changes instead of management. Even a couple of past challenging staff members are now championing the changes thanks to an increase in autonomy to make the changes they knew would have an impact.
  • Improved caseworker competencies through new standardized training processes 
  • The Union dropped their concerns!

Conclusions

Leaders drive change, from small departmental processes to large-scale organizational changes. Although many leaders understand the value of having their staff help develop solutions to change, they often encounter resistance with little to no clear way to move forward. Despite having success in the end, CMHA faced this dilemma many times. 

With the support of the Evolution of Thinking™ program, including the tools, ongoing coaching, and help from the Instincts at Work team, CMHA became clear about how to communicate the vision of their new case management model. They successfully managed the staff and their threat responses around the perceived barriers to success and used an experimental approach in the implementation phase that yielded incredible results. 

Marilyn revealed, ''In the past I questioned how my contributions were received and whether I was seen as providing value. With the tools, I stepped into leading in a new way, with confidence.  This project has improved my sense of personal contribution to a major quality improvement initiative and has allowed me the opportunity to create, communicate, and help drive a new program.' 

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